Simplify and optimize the diagnosis and treatment of pulmonary hypertension: to decipher 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension
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摘要: 《2022 ESC/ERS肺高血压诊治指南》于今年8月26日重磅发布。时隔7年，新版指南在肺高血压的定义、分型、诊断和治疗等方面进行了更新，更多循证医学证据的出现支持了本次指南的更新，为临床实践带来了新的理念与观点。指南的更新反映学界对肺高血压的认识日益深刻，给临床医生提供了更为全面的指导。Abstract: The 2022 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension was released on August 26 this year. After a lapse of seven years, the new version of the guidelines has been updated in many aspects such as the classification, diagnosis, and treatment of pulmonary hypertension. The update to the guideline reflects a profound change in the understanding of pulmonary hypertension.
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图 1 2022 ESC/ERS肺高血压指南的诊断和治疗指南总览
Figure 1. The overview in 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension
图 3 不明原因呼吸困难或疑似肺高血压的初筛
Figure 3. Screening for unexplained dyspnea or suspected pulmonary hypertension
图 5 非先天性心脏病相关PAH靶向治疗流程
Figure 5. Treatment algorithm for patients with non-CHD associated PAH
图 6 CTEPH治疗/多模式方法的选择
Figure 6. Overlap in treatments/multimodality approaches in CTEPH
表 1 肺高血压的定义和血流动力学特征
Table 1. Definition and hemodynamics characteristics of pulmonary hypertension
定义 血流动力学特征 肺高血压 mPAP > 20 mmHg 毛细血管前肺高血压 mPAP > 20 mmHg，PAWP≤15 mmHg，PVR > 2 Wood 毛细血管后肺高血压 mPAP > 20 mmHg，PAWP > 15 mmHg，PVR≤2 Wood 混合性毛细血管前和后肺高血压 mPAP > 20 mmHg，PAWP > 15 mmHg，PVR > 2 Wood 运动肺高血压 运动较静息mPAP/CO > 3 mmHg·L-1·min-1 
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表 2 PAH的危险分层
Table 2. Risk stratification of PAH
指标 低危 中低危 中高危 高危 分值 1 2 3 4 WHO功能分级 Ⅰ或Ⅱ — Ⅲ Ⅳ 6 min步行距离/min > 440 320~440 165~319 < 165 BNP/NT-proBNP/(ng·L-1) < 50/ < 300 50~199/300~649 200~800/650~1100 > 800/ > 1100
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[1] Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension[J]. Eur Heart J, 2022. doi:10.1093/eurheartj/ehac237.
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